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NORTHWEST NEUROLOGY, LTD fax number
(847) 882-6228
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Neurology
Used for: Medical records requests / authorization to release information; typically used for sending or receiving patient records, referrals, and related confirmations.
Fax destination details
- Department
- Neurology
- Purpose
- Medical records requests / authorization to release information; typically used for sending or receiving patient records, referrals, and related confirmations.
- Form
- Authorization to Release Information — Authorization to Release Information
- Address
- 22285 N Pepper Rd, Suite 401, Lake Barrington, IL 60010
- Voice phone
- 847-882-6604
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
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Provide patient identifying details, authorize the release scope (which records to release), recipient, and expiration; sign and date the form.
Official form instructions are published as a downloadable file on the organization's website.
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